Systematic Review of Traumatic Brain Injury and the Impact of Antioxidant Therapy on Clinical Outcomes

Worldviews Evid Based Nurs. 2016 Oct;13(5):380-389. doi: 10.1111/wvn.12167. Epub 2016 May 31.


Background: Traumatic brain injury (TBI) is an acquired brain injury that occurs when there is sudden trauma that leads to brain damage. This acute complex event can happen when the head is violently or suddenly struck or an object pierces the skull or brain. The current principal treatment of TBI includes various pharmaceutical agents, hyperbaric oxygen, and hypothermia. There is evidence that secondary injury from a TBI is specifically related to oxidative stress. However, the clinical management of TBI often does not include antioxidants to reduce oxidative stress and prevent secondary injury.

Aims: The purpose of this article is to examine current literature regarding the use of antioxidant therapies in treating TBI. This review evaluates the evidence of antioxidant therapy as an adjunctive treatment used to reduce the underlying mechanisms involved in secondary TBI injury.

Methods: A systematic review of the literature published between January 2005 and September 2015 was conducted. Five databases were searched including CINAHL, PubMed, the Cochrane Library, PsycINFO, and Web of Science.

Findings: Critical evaluation of the six studies that met inclusion criteria suggests that antioxidant therapies such as amino acids, vitamins C and E, progesterone, N-acetylcysteine, and enzogenol may be safe and effective adjunctive therapies in adult patients with TBI. Although certain limitations were found, the overall trend of using antioxidant therapies to improve the clinical outcomes of TBI was positive.

Linking evidence to action: By incorporating antioxidant therapies into practice, clinicians can help attenuate the oxidative posttraumatic brain damage and optimize patients' recovery.

Keywords: adjunctive therapy; antioxidant therapy; mitochondrial injury; oxidative stress; secondary injury; traumatic brain injury.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Acetylcysteine / pharmacology
  • Acetylcysteine / therapeutic use
  • Adult
  • Amino Acids / pharmacology
  • Amino Acids / therapeutic use
  • Antioxidants / pharmacology*
  • Antioxidants / therapeutic use*
  • Ascorbic Acid / pharmacology
  • Ascorbic Acid / therapeutic use
  • Brain Injuries, Traumatic / drug therapy*
  • Female
  • Flavonoids / pharmacology
  • Flavonoids / therapeutic use
  • Humans
  • Male
  • Progesterone / pharmacology
  • Progesterone / therapeutic use
  • Quercetin / analogs & derivatives
  • Quercetin / pharmacology
  • Quercetin / therapeutic use
  • Treatment Outcome*
  • Vitamin E / pharmacology
  • Vitamin E / therapeutic use


  • Amino Acids
  • Antioxidants
  • Flavonoids
  • enzogenol
  • Vitamin E
  • Progesterone
  • Quercetin
  • Ascorbic Acid
  • Acetylcysteine